A patient with subcutaneous-insulin resistance treated by insulin lispro plus heparin

Severe resistance to subcutaneous insulin but sensitivity to intravenous in sulin persisted for 11 years in a 23-year-old diabetic woman. Several thera peutic trials revealed that (1) intravenous regular insulin improved her me tabolic controls (2) continuous subcutaneous infusion (CSII) treatment with regular insulin or insulin lispro caused hyperglycemic period with hypoins ulinemia and hypoglycemic period with hyperinsulinemia alternately; (3) add ing heparin to insulin lispro in CSII resulted in dramatic increase of seru m insulin level and improvement of glycemic control; and (4) regular insuli n plus heparin in CSII could not increase serum insulin level and thus the glycemic values was not improved. From these results, the patient followed the insulin lispro plus heparin protocol and obtained a better glycemic con trol without any adverse events. Effectiveness of this therapy may lead us to further understanding of pathophysiology of this syndrome. (C) 2001 Else vier Science Ireland Ltd. All rights reserved.